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},
"code": "K50",
"name": "Регионарный энтерит",
"icd_name": "Болезнь Крона [регионарный энтерит]",
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3,
0
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"lead": "хроническое рецидивирующее заболевание кишечника аутоиммунной природы, когда в воспалительный процесс вовлекаются все слои кишечника",
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"etiology": "<p>Природа заболевания не выяснена. Существуют инфекционная, алиментарная и аутоиммунная теории. Трансмуральные воспалительные изменения могут быть единичными или множественными, при этом измененные участки чередуются с неизмененными.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагностика производится на основании характерной клинической картины, данных объективного осмотра, результатов лабораторно-инструментальных методов исследования. Рентгенологическая картина представляет собой «булыжную мостовую» с сегментарными сужениями пораженных участков («симптом шнура»).</p>",
"treatment": "<p>Во время незначительной активности заболевания и в целях стабилизации ремиссии назначают сульфасалазин и препараты 5-АСК – баминосалициловая кислота, при обострениях – глюкокортикоиды, иммунодепрессанты. Для терапии гнойных осложнений болезни Крона применяются антибиотики широкого спектра действия.</p>",
"prevention": "",
"clinical_picture": "<p>Симптомы заболевания обусловлены локализацией патологического процесса: в тонкой или толстой кишке, желудке, пищеводе, на слизистой оболочке рта. Внекишечные признаки болезни: кожные заболевания (узловатая <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">эритема</a>, <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">Шелушение</a> кожи\">псориаз</a> и т. д.), поражения суставов (артриты, сакроилеит), воспалительные заболевания глаз, заболевания печени и желчевыводящих путей, васкулит, амилоидоз, остеопороз.</p>",
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4932,
5099
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},
"code": "K46",
"name": "Грыжа брюшной полости",
"icd_name": "Грыжа брюшной полости неуточненная",
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3,
0
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"slug": "k46_gryzha_bryushnoy_polosti",
"lead": "выхождение внутренних органов через естественные либо приобретенные отверстия",
"description": "",
"etiology": "<p>Грыжи возникают вследствие действия различных неблагоприятных факторов. Предрасполагающими факторами являются астеническое или гиперстеническое телосложение, резкое снижение или повышение массы тела, молодой или пожилой возраст, увеличение в объеме органов брюшной полости. Также образованию грыж способствуют травмы или атрофия мышц передней брюшной стенки, запоры и <a href=\"/symptom/meteorizm/\" title=\"Перейти на страницу симптома Метеоризм\">вздутие</a> живота, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, затяжные роды, <a href=\"/symptom/ascit/\" title=\"Перейти на страницу симптома Асцит\">асцит</a>, беременность.</p>",
"pathogenesis": "<p>Составными частями грыжи являются грыжевые ворота, грыжевой мешок и грыжевое содержимое. В грыжевом мешке выделяют устье, шейку, тело, дно.</p>\r\n<p>К внутренним грыжам относят диафрагмальные грыжи и грыжи внутреннего ущемления. Диафрагмальные грыжи подразделяются на истинные (грыжевым мешком являются париетальная брюшина и париетальная плевра) и ложные (врожденные, при которых отсутствует грыжевой мешок). Грыжи пищеводного отверстия диафрагмы подразделяются на скользящие и параэзофагеальные. Скользящие грыжи подразделяются на кардиальные, пищеводные, кардиофундальные, желудочные субтотальные и тотальные. Параэзофагеальные грыжи подразделяются на фундальные, антральные, кишечные, желудочно-кишечные, сальниковые.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра. Необходимо проведение рентгеноконтрастного исследования, УЗИ, эзофагоскопии, внутрипищеводной pH-метрии.</p>",
"treatment": "<p>Неосложненные скользящие грыжи подлежат консервативной терапии (назначается прием щелочных растворов, антацидов, обволакивающих средств, седативных средств, а также местных анестетиков). Оперативное лечение показано при наличии параэзофагеальных грыж, пептических стриктур, кровотечения, при безуспешности консервативной терапии. Методы оперативного вмешательства: крурорафия, низведение органов.</p>",
"prevention": "",
"clinical_picture": "<p>Скользящие грыжи характеризуются развитием рефлюкс-эзофагита. Больные предъявляют жалобы на жгучие боли за грудиной, усиливающиеся при наклонах туловища, в горизонтальном положении. Возможно появление дисфагии при развитии стриктуры пищевода. При появлении пептического эзофагита возможно появление кровотечения.</p>\r\n<p>Для параэзофагеальных грыж также характерны жалобы на боли за грудиной, развитие дисфагии. Параэзофагеальные грыжи склонны к ущемлению. При развитии ущемления появляются <a href=\"/symptom/kolika/\" title=\"Перейти на страницу симптома Колика\">резкая боль</a>, а также <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> с кровью.</p>",
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},
"code": "A43",
"name": "Нокардиоз",
"icd_name": "Нокардиоз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"4"
],
"periodicity": 1,
"slug": "a43_nokardioz",
"lead": "глубокий псевдомикоз, возбудитель которого вызывает гнойно-гранулематозное поражение легких, кожи и внутренних органов",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заражение у людей вызывают несколько видов Nocardia. Nocardia asteroides обычно вызывает инфекции легких и всего организма. Другие виды обычно вызывают кожные инфекции, особенно у людей, живущих в тропическом климате.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Люди заражаются, когда:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">они вдыхают пыль, содержащую бактерии Nocardia, что приводит к инфекции легких;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">почва или вода, содержащая бактерии, попадает в кожу через порез или царапину, что приводит к инфекции кожи.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нокардиоз редко передается от человека к человеку.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Бактерии Nocardia могут распространиться на соседние ткани или через кровоток, заражая любой орган. Они чаще всего заражают мозг, кожу, почки, кости или мышцы. Абсцессы (скопления гноя) могут образовываться в инфицированных органах.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нокардиоз встречается во всем мире у людей всех возрастов. Но чаще всего он встречается среди пожилых людей, особенно мужчин, и у людей с ослабленной иммунной системой. Любое из следующих нарушений, ослабляющих иммунную систему, увеличивает риск заражения нокардиозом:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие определенных онкологических заболеваний (таких как ходжкинская лимфома);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие пересаженного органа;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прием высоких доз кортикостероидов и/или других препаратов, подавляющих иммунную систему;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">болезнь легких;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">поздняя стадия ВИЧ /СПИД.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нокардиоз считается оппортунистической инфекцией, потому что происходит у людей с ослабленной иммунной системой. Однако около 20–30% людей с нокардиозом не имеют нарушения или заболевания, повышающего риск заражения.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Входные ворота инфекции – слизистая оболочка дыхательных путей, кишечника, конъюнктивы глаза, раны. Нокардиоз обычно развивается на фоне сниженной резистентности макроорганизма: при хронических заболеваниях крови, онкологических процессах, длительном лечении кортикостероидами, иммунодепрессантами, противоопухолевыми антибиотиками. Обычно нокардиоз начинается как легочная инфекция, для которой характерно образование мелких бугорков, напоминающих туберкулезные. Далее процесс может развиваться местно (образуются каверны, абсцессы, свищи) или происходит диссеминация возбудителя лимфогенным или гематогенным путем. В этом случае могут наблюдаться абсцессы мозга, почек, других органов и тканей.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Подтверждение диагноза возможно при сопоставлении клинической картины нокардиоза с лабораторно-инструментальными данными. При легочной форме рентгенография легких обнаруживает картину сливной бронхопневмонии с полостями распада. При диссеминированной форме с помощью КТ и МРТ выявляются внутримозговые абсцессы и вторичные гнойные очаги во внутренних органах.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделение возбудителя нокардиоза из клинического материала (мокроты, бронхиальных смывов, экссудата, крови, мочи, гноя, цереброспинальной жидкости, биоптатов) производится с помощью микроскопии, бактериологического посева, ПЦР. Дополнительно могут применяться серологические исследования (реакция агглютинации, преципитации, связывания комплемента), кожные аллергические пробы.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение нокардиоза должно включать пролонгированную химиотерапию и хирургическое дренирование гнойных очагов. Для этиотропной химиотерапии нокардиоза применяются сульфани­ламидные препараты (сульфадимидин, сульфадиазин – в течение нескольких месяцев), сульфаметоксазол+триметоприм, антибиотики (имипенем, амикацин, цефотаксим, цефтриаксон, тетрациклины – курс 4-6 недель). При нокардиозе может встать вопрос о дренировании плевральной полости, оперативном лечении абсцессов головного мозга, вскрытии абсцессов мягких тканей и т. д.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При легочном нокардиозе летальность составляет около 10%, при септической форме инфекции – 50%. Изолированная кожная форма нокардиоза протекает доброкачественно. Иммунопрофилактика нокардиоза не разработана. Избежать заражения патогенными микроорганизмами позволяет предупреждение травм кожи, ношение защитной одежды и обуви при контакте с землей, повышение иммунной реактивности.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принципы профилактики прежде всего сводятся к избеганию попадания земли в раны, а также к повышению уровня иммунной защиты. Кроме этого, по возможности следует защищать себя от вдыхания запыленного воздуха.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Большинство случаев нокардиоза начинаются с легочных инфекций, которые развиваются в абсцессы легких. Симптомы нокардиоза могут включать:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боль в груди;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">кашель;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">кровянистую мокроту;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потливость;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">озноб;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">слабость;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">отсутствие аппетита;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потерю веса;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">затрудненное дыхание (одышка).</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы нокардиоза схожи с симптомами пневмонии и туберкулеза легких.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инфекция может распространяться через кровоток, приводя к абсцессам в головном мозге, где они действительно очень серьезны, или реже, в почках, кишечнике или других органах. 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"code": "K44",
"name": "Диафрагмальная грыжа",
"icd_name": "Диафрагмальная грыжа",
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"lead": "врожденная неправильность развития в виде анатомического дефекта в области прохождения через диафрагму органов, иногда значительное недоразвитие диафрагмы. Приобретенные грыжи возникают реже, при повреждениях диафрагмы",
"description": "",
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"treatment": "<p>Хирургическое при всех видах диафрагмальных грыж.</p>",
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},
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"pathogenesis": "<p>Составными частями грыжи являются грыжевые ворота, грыжевой мешок и грыжевое содержимое. В грыжевом мешке выделяют устье, шейку, тело, дно.</p>",
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